Although about 10 percent of patients with systemic hypertension have a basal diastolic blowing murmur indicating aortic regurgitation (AR), the degree of aortic regurgitation from systemic hypertension unassociated with aortic dissection is rare, but we described such a patient who had aortic regurgitation severe enough to require aortic valve replacement. Our patient had systemic hypertension and aortic regurgitation severe enough to warrant aortic-valve replacement without clinical or morphologic explanation for the aortic regurgitation other than systemic hypertension. Recently, we reported four other patients, all men aged 43-59 years (mean 50), with severe systemic hypertension, chronic congestive heart failure, and aortic regurgitation severe enough to warrant aortic-valve replacement. The hypertension had been present from 1-30 years (mean 13). In each of the four previous patients and in the present patient, the aortic valve was three-cuspid; each cusp was free of calcific deposits and freely mobile. Until these five patients were encountered, we had not observed severe aortic regurgitation from systemic hypertension alone and are unaware of any reports describing aortic valve replacement for aortic regurgitation in such patients.